Mark D. White

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I’m a professor in the Department of Philosophy at the College of Staten Island/CUNY, where I teach courses in philosophy, economics, and law, and the author/editor/co-editor of several books.

David Brooks on health care reform and the values question

Mark D. White

In his recent column, "The Values Question," David Brooks definitely has the right idea in general regarding health care reform, making a bold statement that I completely agree with (especially the bolded part, emphasis mine):

It’s easy to get lost in the weeds when talking about health care reform. But, like all great public issues, the health care debate is fundamentally a debate about values. It’s a debate about what kind of country we want America to be.

At their core, great public issues are rarely economic–they're ethical. Focusing on costs–whether we're discussing health care, national security, and so on–misses the point, since it assumes that costs are the only (or most) relevant factor, and this is itself a normative statement. While costs may be a critical component of any public debate (especially when scarce resources are involved), they are rarely to be considered to the exclusion of other values (such as justice, dignity, rights, and so on).

Brooks ends on the same note:

We all have to decide what we want at this moment in history, vitality or security. We can debate this or that provision, but where we come down will depend on that moral preference. Don’t get stupefied by technical details. This debate is about values.

While I disagree with most of how Brooks fleshes out the debate, I do appreciate that he is focusing on values, which is what the debate truly is (or should be) about. I hope to have much more to say on this in the future.

Any thoughts?

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2 responses to “David Brooks on health care reform and the values question”

  1. Jonathan Avatar
    Jonathan

    Thanks for posting this, as I’d missed Brooks’ column. Overall, I think he’s right. But in posing the trade-off as between security and vitality, Brooks misses two points:
    (1) that health insurance security will allow workers to migrate more easily between jobs and to start their own companies; and (2) that public health problems (e.g., contagious illnesses) will be better controlled if insurance is extended to those most at risk. So “vitality” cannot simply be measured by explicit costs within the health sector itself.
    More importantly, perhaps Brooks is wrong and we should talk about costs. Is it ethical to spend 50% of all health funds to preserve the lives of terminally ill patients a few more months? Would it be ethical to offer patients a choice of treatments? (Take $150,000 cash to leave to your heirs and we’ll give you lots of pain meds but no heroic treatments; or, we’ll spend $300,000 on heroic procedures that are painful and will make your last months hell.)

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  2. Mark D. White Avatar
    Mark D. White

    Three comments in reply, Jonathan:
    1) Your point about worker flexibility is very important, but could be achieved by severing the link between employers and health insurance.
    2) Contagions can be dealt with by case-specific measures (universal innoculation programs, for instance) – there is no need for universal health insurance to cover this, since the innoculation itself is insurance.
    3) Let me put your question about costs another way: is it ethical to make individual persons’ and families’ health care choices for them? There is no reason for “us” to talk about costs; in a just system, each person, along with his or her family and doctor, would decide what costs they choose to bear for which treatments, operations, or long-term care, based on their unique circumstances, constraints, goals, concerns, and priorities.

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